| NPI | 1003032574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 50685) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP00188) |
| 207R00000X Internal Medicine (Licence: NH 15311) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2011-09-12 |